Independent NAC OSCE preparation by BoardQBank
Cardiovascular examRespiratory examAbdominal examMurmur soundsOfficial resourcessupport@boardqbank.com
NAC OSCE logoNAC OSCEBoardQBank preparation
⌂
Important: Exam dates, fees and policies can change. Verify time-sensitive details on the official Medical Council of Canada website.
Home / Agitation and behavioural emergency
Mental health — complete topic guide

Agitation and behavioural emergency

Turn this presentation into an 11-minute OSCE performance: focused assessment, prioritized differential, targeted examination and investigations, immediate management, communication, disposition and safety-netting.

What you must demonstrate

  • Structured mental-status examination
  • Direct suicide and violence questions
  • Substance and medication history
  • Capacity assessment
  • Collaborative safety planning
Do not miss: Active suicidal intent · Violence risk · Command hallucinations · Delirium/medical cause · Inability to care for self

11-minute performance map

0:00–0:45

1. Opening and immediate safety

Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.

0:45–4:30

2. Focused assessment

Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.

4:30–6:30

3. Targeted examination

Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.

6:30–7:30

4. Synthesize

Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.

7:30–8:40

5. Investigations

Choose tests that answer a specific diagnostic or safety question; state urgent tests first.

8:40–10:15

6. Immediate management

Treat instability, begin syndrome-specific care, consult early when needed and define disposition.

10:15–11:00

7. Communication and safety net

Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.

Focused history prompts

Define the presentation

  • Onset, chronology, triggers and progression.
  • Severity and effect on function.
  • Associated symptoms that support the leading diagnosis.
  • Relevant negatives that reduce dangerous alternatives.

Risk context

  • Relevant past medical/surgical/obstetric/psychiatric history.
  • Medications, allergies and adherence.
  • Family, social, substance, travel/exposure or safeguarding factors as applicable.
  • Patient ideas, concerns, expectations and goals.

Dangerous alternatives to prioritize

  1. Active suicidal intent
  2. Violence risk
  3. Command hallucinations
  4. Delirium/medical cause
  5. Inability to care for self

Targeted investigations

Collateral history and medication/substance review

Bedside glucose and focused medical screen in acute/first presentations

Targeted CBC/electrolytes/renal/hepatic/thyroid/toxicology testing when clinically indicated

ECG or imaging only when the presentation or treatment makes it necessary

Immediate management and disposition

  1. Ensure immediate safety and use least-restrictive measures.
  2. Treat medical causes, intoxication or withdrawal when present.
  3. Assess suicide/violence risk and capacity when relevant.
  4. Arrange psychiatric consultation, safety planning and disposition matched to risk.
High-yield closing sentence: “I would reassess after the initial intervention, escalate if there is deterioration, explain the plan in plain language, confirm understanding and give specific safety-net instructions.”

Related complete stations

11 minutes

Depression with suicidal thoughts

Ask directly about suicide and create a safe disposition.

11 minutes

First-episode psychosis

Assess psychosis, risk, substances and medical causes.

11 minutes

Severely agitated patient

Protect safety, search medical causes and use least restrictive intervention.

11 minutes

Sudden focal weakness

Activate the stroke pathway and avoid preventable delay.